Lashes Consent Form
@thefinerbeauty
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Health History | Please check any of the following:
Allergic to glycerin, latex, cyanoacrylate, or acrylic
Allergic to nail glue
Allergic to adhesive band-aid or medical tape
Have an eye illness-injury
Have inflamed eyelids
Have permanent eye make-up
Eye-lift
Other
Have you had eyelash extension before?
Yes
No
Please read carefully the following instructions: Extensions are individual synthetic material that is attached to your own eyelashes, not to your skin. These lashes can stay up to 2 months with proper care and maintenance that depends on the individual, lifestyle, and eyelash growth. After implementation, please DO NOT: try to remove eyelash extensions on your own use a regular eyelash curler rub your eyes or lashes pull your lash extensions go to sauna use mascara cut the extension By signing this appointment and consent form, I, hereby, acknowledge, consent, and agree to all of the following: I have read and understood the instructions above. The eyelash extension procedure requires synthetic eyelashes to be glued to my own natural eyelashes. It is my responsibility to keep my eyes closed and be still during the entire procedure until the technician leads me to do the opposite. There are some risks of this procedure may be but not limited to eye redness and irritation. The fumes from the adhesive may cause my eyes to tear up if I do not keep my eyes closed. I disclosed any allergies that I may have. I need to follow the after-care instructions and for any unexpected circumstances due to not following these instructions are at my own risk. I confirm and agree that I wish to engage eyelash extension services at your business in my own will.
Date
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Month
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Day
Year
Date
Signature
Submit
Should be Empty:
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